Diseases of the Urinary System and Therapeutics

Question 1

Are the kidneys in the intra- or retroperitoneal space?

Answer 1

Retroperitoneal

Question 2

Which kidney is more cranial?

Answer 2

Right slightly more cranial than left

Question 3

What is azotemia?

Answer 3

Elevation of urea and/or creatinine in the bloodstream

Question 4

What is uraemia?

Answer 4

The clinical signs associated with azotaemia

Question 5

What is polyuria?

Answer 5

Excessive urine production

Question 6

What is oliguria?

Answer 6

Production of a very small amount of urine (inadequate)

Question 7

What is anuria?

Answer 7

Absence of urine

Question 8

What is polydipsia?

Answer 8

Excessive water intake

Question 9

What is pyelonephritis?

Answer 9

Bacteria kidney infection (may be unilateral or bilateral)

Question 10

What is glomerunephritis?

Answer 10

Inflammation of the glomeruli

Question 11

What is renal insufficiency?

Answer 11

A measurable reduction in kidney function

Question 12

How long must pass before kidney disease is considered chronic?

Answer 12

> 3 months

Question 13

What is usually the first readily measurable sign of kidney disease?

Answer 13

Inability to concentrate urine

Question 14

What is hypersthenuria?

Answer 14

Excretion of urine with an unusually high specific gravity

Question 15

What is hyposthenuria?

Answer 15

Excretion of urine with an unusually low specific gravity

Question 16

What USG is considered normal for cats and dogs?

Answer 16

Dogs >1.030

Cats >1.035

Question 17

What USG is considered hyposthenuria?

Answer 17

<1.008

Question 18

What main types of urinalysis are there?

Answer 18

USG testing 
Dipstix analysis 
Microscopy 
Cytology 
Bacterial culture and sensitivity

Question 19

Why do we test specifically for urea and creatinine?

Answer 19

They are both endogenous waste products excreted by the kidneys (= good measure of kidney function)

Question 20

Why should you take a fasted blood sample?

Answer 20

A recent protein meal will falsely raise urea

Question 21

What does azotaemia indicate in terms of kidney function?

Answer 21

Indicates reduced glomerular filtration of blood

Question 22

What causes pre-renal azotaemia?

Answer 22

Inadequate renal perfusion

Question 23

What causes renal azotaemia?

Answer 23

Reduced functional mass of the kidneys due to underlying kidney disease

Question 24

What causes post-renal azotaemia?

Answer 24

Obstruction of the ureters or urethra

Rupture of the urinary tract (= uroabdomen)

Question 25

What is the body's response to a pre-renal azotemia?

Answer 25

To preserve as much water as possible = production of concentrated urine

Question 26

What is the result (urine-wise) of a renal azotemia?

Answer 26

Poorly concentrated urine (less than hypersthenuria)

Question 27

What effect can kidney disease have on phosphates in the blood?

Answer 27

Hyperphosphataemia common - reflects reduced renal function

Question 28

What effect can kidney disease have on potassium levels?

Answer 28

Hypokalaemia common as a direct consequence of kidney disease - contributes to weakness and inappetence

Question 29

What effect can kidney disease have on red blood cells?

Answer 29

Anaemia = erythropoietin is synthesised by the kidney | RBCs in uraemic px have a reduced lifespan

Question 30

With what type of kidney damage will patients present more unwell?

Answer 30

Acute kidney injury

Question 31

What level of urine excretion do acute kidney injury patients commonly present with?

Answer 31

Anuria or oliguria

Question 32

What common toxins can cause acute kidney injury?

Answer 32

``` Cholecalciferol (vit D) Ethylene glycol (antifreeze) Grapes/raisins Lilies (cats only) Ibuprofen/NSAIDs ```

Question 33

What are the clinical findings you expect with acute kidney dysfunction?

Answer 33

Lethargic, depressed Inappetent and nauseous Cardiac arrhythmias/arrest Volume overload (an/oliguria)

Question 34

What specific clinical sign do you see with ethylene glycol toxicity?

Answer 34

Tremors (hypocalcaemia)

Question 35

What specific clinical sign do you see with leptospirosis?

Answer 35

Icterus

Question 36

What blood findings are used to diagnose acute azotemia?

Answer 36

Increased urea/creatinine/phosphate Increased K+ if anuric/oliguric Decreased K+ if polyuric

Question 37

How should AKI be managed?

Answer 37

Remove underlying cause (nephrotoxic drugs/toxins/gastric decontamination) Manage fluid balance/electrolytes/uraemic toxins Supplementary management of nutrition/nausea/pain

Question 38

Which crystalloids are most appropriate for managing AKI?

Answer 38

Hartmanns

Question 39

What are the main objectives for initial fluid therapy of AKI?

Answer 39

Correct any hypovolaemia (pre-renal component) Once euvolaemic, correct any dehydration (0ver 6 hours)

Question 40

What are the effects of hyperkalaemia on the heart?

Answer 40

Reduced pacemaker activity May be bradycardic Ventricular fibrillation Cardiac arrest if severe

Question 41

How can hyperkalaemia be identified on an ECG trace?

Answer 41

Wide QRS Flattened P Spiked T

Question 42

What is the purpose of giving calcium gluconate for hyperkalaemia?

Answer 42

Helps stabilise the myocardium

Question 43

What is the purpose of giving glucose and/or insulin for hyperkalaemia?

Answer 43

Glucose stimulates release of insulin | Insulin stimulates uptake of potassium into cells

Question 44

What specific therapy should be used for ethylene glycol toxicity?

Answer 44

Medical-grade ethanol

Question 45

What type of therapy should be used to treat leptospirosis/pyelonephritis?

Answer 45

Antibiotics

Question 46

What are the indications for dialysis or euthanasia?

Answer 46

Persistent anuria +/- volume overload persistent unmanageable hyperkalaemia

Question 47

What treatment should be considered if px fails to respond to treatments for anuria?

Answer 47

Consider trial diuretic - 2mg/kg frusemide ONCE